| Objective To compare the efficacy of erythromycin and metoclopramide in the treatment of feed intolerance in critically ill patients, and determine the effectiveness of “rescue” combination therapy in patients who fail monotherapy.Methods From 2013.10 to 2014.10 the ICU patients were collected. The patients with enteral nutrition indications, is expected to >7 days in patients with enteral nutrition. Patients received either erythromycin 250 mg or metoclopramide 10 mg intravenously two times daily. If a gastric residual volume(GRV) >250m L recurred on treatment twice in the first 24 h and once after the first 24 h, it mean therapy failure. And than open-label, combination therapy was given. Patients were studied for 7 days. Demographic data, blood glucose levels, and use of inotropes, opioids, and benzodiazepines were similar between the two groups. Observe the success rate and the gastric residual volume in each group. Differences in demographic characteristics between critically ill patients treated with erythromycin and metoclopramide were assessed using the unpaired Student’s t-test for continuous data and chi-square test for categorical data. Differences in the time to develop feed intolerance while on therapy between the two treatment groups were expressed as median and interquartile range and were compared using Mann-Whitney U test. Risk factors for poor response to prokinetic therapy were assessed by logistic regression. All data are mean±SEM. P value of <0.05 was considered statistically significant.Result The results were included in this study the erythromycin group 60 cases, metoclopramide group 60 cases. The intervention group, erythromycin and metoclopramide group were 30 cases and 37 cases of patients with feeding failure. All included in the treatment group, remedial measures, the observation process off again in 13 patients, 51 patients completed the treatment process of remedial measures. After treated with 13 patients still can’t relieve gastric retention, including 10 cases of endoscopic operation in jejunum nutrient canal. The GRV of success patients who used erythromycin were more effective than who used metoclopramide in the 1 to 4 days(P<0.04). In the whole course, the glucose, ALT, AST, ALP and GGT had no statistical significance in the two groups. Comparison of feeding and failure patients in erythromycin group, the incidence of infection(8 cases vs.21 cases, P=0.01), average hospitalization days(17.3±3.2d vs. 25.1±5.6d, P<0.001), ICU duration of hospital stay(9.2±2.1d vs. 14.8±4.3d, P<0.001) had statistical significance. The same as metoclopramide group in average hospitalization days(18.5±2.7d vs. 23.9±4.8d, P<0.001) and ICU duration of hospital stay(10.8±2.6d vs. 14.5±3.9d, P<0.001). Success rate of erythromycin group was compared with metoclopramide group that had statistical significance(P<0.05) in the 1 to 4 days, with combination group that had statistical significance(P<0.05) in the 5 to 7 days. The cumulative adverse reactions occurred 12 cases in erythromycin group, 8 cases in the treatment group and 5 cases in the combined treatment group. The related independent risk factors of influence of erythromycin or metoclopramide therapy efficacy was the gastric remnant(P=0.01).Conclusion In critical illness, erythromycin is more effective than metoclopramide intravenously in treating feed intolerance, and early application have more remarkable efficiency. Rescue combination therapy is highly effective, and has longer duration of action. |
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